Sex education classes that focus on encouraging children to remain abstinent can persuade a significant proportion to delay sexual activity, researchers reported Monday in a landmark study that could have major implications for U.S. efforts to protect young people against unwanted pregnancies and sexually transmitted diseases.

Only about a third of sixth- and seventh-graders who completed an abstinence-focused program started having sex within the next two years, researchers found. Nearly half of the students who attended other classes, including ones that combined information about abstinence and contraception, became sexually active.

The findings are the first clear evidence that an abstinence program could work.

"I think we've written off abstinence-only education without looking closely at the nature of the evidence," said John B. Jemmott III, a professor at the University of Pennsylvania who led the federally funded study. "Our study shows this could be one approach that could be used."

The research, published in the Archives of Pediatric & Adolescent Medicine, comes amid intense debate over how to reduce sexual activity, pregnancies, births and sexually transmitted diseases among children and teenagers. After falling for more than a decade, the numbers of births, pregnancies and STDs among U.S. teens have begun increasing.

The Obama administration eliminated more than $170 million in annual federal funding targeted at abstinence programs after a series of reports concluded that the approach was ineffective. Instead, the White House is launching a $114 million pregnancy prevention initiative that will fund only programs that have been shown scientifically to work -- a program the administration on Monday proposed expanding to $183 million.

"This new study is game-changing," said Sarah Brown, who leads the National Campaign to Prevent Teen and Unplanned Pregnancy. "For the first time, there is strong evidence that an abstinence-only intervention can help very young teens delay sex."

The study is the first to evaluate an abstinence program using a carefully designed approach comparing it with several alternative strategies and following subjects for an extended period of time, considered the kind of study that produces the highest level of scientific evidence.

Good question. The abstract indicates (this is just the results section)...

Archives of Pediatric & Adolescent Medicine said:

The participants' mean age was 12.2 years; 53.5% were girls; and 84.4% were still enrolled at 24 months. Abstinence-only intervention reduced sexual initiation (risk ratio [RR], 0.67; 95% confidence interval [CI], 0.48-0.96). The model-estimated probability of ever having sexual intercourse by the 24-month follow-up was 33.5% in the abstinence-only intervention and 48.5% in the control group. Fewer abstinence-only intervention participants (20.6%) than control participants (29.0%) reported having coitus in the previous 3 months during the follow-up period (RR, 0.94; 95% CI, 0.90-0.99). Abstinence-only intervention did not affect condom use. The 8-hour (RR, 0.96; 95% CI, 0.92-1.00) and 12-hour comprehensive (RR, 0.95; 95% CI, 0.91-0.99) interventions reduced reports of having multiple partners compared with the control group. No other differences between interventions and controls were significant.

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The abstract specifically mentions coitus, so I'd be curious if engaging in other sex activities was also investigated. One part of the abstinence program in this intervention was specifically dispelling sex-related myths, so presumably there was coverage for ideas like the myth that oral sex is risk-free.

Conservatives have long supported abstinence-based sex education programs and such programs were condemned as ineffective by educators - now comes clear evidence of program success; "The findings are the first clear evidence that an abstinence program could work." Let's see if the NEA will drop its objections to such effective programs and whether a renewed emphasis upon such abstinence-based sex education programs will be adopted by the federal government.

Outcome Measures The primary outcome was self-report of ever having sexual intercourse by the 24-month follow-up. Secondary outcomes were other sexual behaviors.

Results The participants' mean age was 12.2 years; 53.5% were girls; and 84.4% were still enrolled at 24 months. Abstinence-only intervention reduced sexual initiation (risk ratio [RR], 0.67; 95% confidence interval [CI], 0.48-0.96). The model-estimated probability of ever having sexual intercourse by the 24-month follow-up was 33.5% in the abstinence-only intervention and 48.5% in the control group. Fewer abstinence-only intervention participants (20.6%) than control participants (29.0%) reported having coitus in the previous 3 months during the follow-up period (RR, 0.94; 95% CI, 0.90-0.99). Abstinence-only intervention did not affect condom use. The 8-hour (RR, 0.96; 95% CI, 0.92-1.00) and 12-hour comprehensive (RR, 0.95; 95% CI, 0.91-0.99) interventions reduced reports of having multiple partners compared with the control group. No other differences between interventions and controls were significant.

Conclusion Theory-based abstinence-only interventions may have an important role in preventing adolescent sexual involvement.

1) Sample size very small - need to expand to larger trials before meaningful results can be derived
2) Sample limited to African-American youth in urban setting. Cannot generalize to other races, settings
3) It appears an either/or. No mention of is abstinence training was given to the "control" groups

I am a healthcare provider to this demographic with a very open mind. I am a man of science. This is a pilot study that SHOULD NOT be used to direct public policy (other than direct more research $). However, it will be politicized out the yazoo!

Usually, the minimum standard for compelling evidence of efficacy if this were a healthcare / medical intervention, would be that there would be at least two trials of this quality that were conducted by different investigators, with the same results.

I am a healthcare provider to this demographic with a very open mind. I am a man of science. This is a pilot study that SHOULD NOT be used to direct public policy (other than direct more research $). However, it will be politicized out the yazoo!

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For a behavioral intervention like this, this sample size really doesn't justify calling it a pilot study. This is a legitimate trial. Like I said above, it needs replication, there need to be additional studies looking at mechanism, and of course, as you say, it needs to be tried on more varied populations of students. But that's no reason to dismiss it completely... if you're a man of science, you'll refrain from the unnecessary capital letters and other propaganda, wouldn't you?

Don't get me wrong -- I'm quite surprised by the results. But, they seem legitimate, and since it worked (and there's really no study I know of that looks at this kind of trial with adequate controls and failed to find a positive result), they deserve further investigation.

Also, if we're honest here, this is not exactly the kind of abstinence-based intervention that conservatives have been bandying about, and if this issue was so important to them, it's quite striking that, in the decades over which they've supported it, they've never managed to produce a high quality trial to demonstrate its efficacy.

Usually, the minimum standard for compelling evidence of efficacy if this were a healthcare / medical intervention, would be that there would be at least two trials of this quality that were conducted by different investigators, with the same results.

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Fair enough... let's do more trials but the initial results are just cause to re-examine abstinence-based intervention and start applying it in other training programs! You seem reluctant to accept these initial positive results even though the results are quite clear.

Also, if we're honest here, this is not exactly the kind of abstinence-based intervention that conservatives have been bandying about

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Could you explain that further? Sure seems like these initial trials validate the abstinence-based education that conservatives have supported for years and years... the distinction you're trying to make is lost on me. Church and religious groups have advocated abstinence-based education for decades and conservatives have stood behind such education. Know who has consistently opposed such education? The NEA teacher's lobby and liberals. So if these trials continue and initial results are validated can we expect to see change?

...and if this issue was so important to them, it's quite striking that, in the decades over which they've supported it, they've never managed to produce a high quality trial to demonstrate its efficacy.

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Done now. So I assume abstinence-based education opponents will now change their tune when further trials validate the initial data? Or will they likely - as I expect - downplay the results?

Usually, the minimum standard for compelling evidence of efficacy if this were a healthcare / medical intervention, would be that there would be at least two trials of this quality that were conducted by different investigators, with the same results.

For a behavioral intervention like this, this sample size really doesn't justify calling it a pilot study. This is a legitimate trial. Like I said above, it needs replication, there need to be additional studies looking at mechanism, and of course, as you say, it needs to be tried on more varied populations of students. But that's no reason to dismiss it completely... if you're a man of science, you'll refrain from the unnecessary capital letters and other propaganda, wouldn't you?

Don't get me wrong -- I'm quite surprised by the results. But, they seem legitimate, and since it worked (and there's really no study I know of that looks at this kind of trial with adequate controls and failed to find a positive result), they deserve further investigation.

Also, if we're honest here, this is not exactly the kind of abstinence-based intervention that conservatives have been bandying about, and if this issue was so important to them, it's quite striking that, in the decades over which they've supported it, they've never managed to produce a high quality trial to demonstrate its efficacy.

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1) Okay, I did overdo it by calling it a pilot study (granted it is a behavioral study). However, these results are not generalizable per se. More studies should be undertaken.
2) The caps were for emphasis rather than propaganda (and even scientists can editorialize)
3) What CAN no longer be said is "there is no evidence of abstinence-only education is effective")
4) While the specific curriculum was not mentioned, you can effectively communicate with adolescents and affect behavior (but you are correct, I suspect this isn't the curriculum promoted by the far right for decades). That some positive results were obtained doesn't surprise me (particularly if the "control" groups didn't receive any toos to say "no")
5) I stand by my comment this will be politicized and inappropriately quoted as gospel by some groups.

Could you explain that further? Sure seems like these initial trials validate the abstinence-based education that conservatives have supported for years and years... the distinction you're trying to make is lost on me.

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I mostly meant that it is (a) not faith-based and (b) has a strong emphasis on providing actual sex education with respect to how diseases are transmitted, etc. Maybe it is more like traditional abstinence-based education than I'm giving it credit for, but on the other hand, I don't think it's unreasonable to infer, from the lack of previous demonstration of efficacy, that there's something different about the program itself that led to the different results.

Done now. So I assume abstinence-based education opponents will now change their tune when further trials validate the initial data? Or will they likely - as I expect - downplay the results?

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I'm willing to listen -- I admit that, conceptually, I'm not a fan of abstinence-based education, but if it works, it works. The idea of needing replication isn't something I (or anyone else) is applying capriciously here, though. It's the way we do business in science and in healthcare. If this were a heart drug, a surgical intervention, or a new psychotherapy technique, we would expect the same. If the replication comes, and it still works, then, sure, I think it should be supported.

I think it's worth a shot. What parent would say they're okay with their 6th-grader being sexually active? They need to have self-control until they're old enough to truly understand the implications of sexual intercourse and the potential effects it can have.

The summary of the study doesn't go into how many of the four different interventions each subject participated in.

If each subject only participated in one intervention, it would be helpful to know if the "8-hour safer sex–only intervention targeted increased condom use" only mentioned condom use or mentioned abstinence as one modality of safer sex practices. If abstinence was omitted from that intervention, then the fact that the subjects who participated in the abstinence-only intervention were more abstinent that those who receive no education about abstinence isn't really a shocker.

Ok, I can't be the only one who noticed the age. These are 12 year old kids being forced to sit through an 8 hour or 12 hour abstinance only program.

I'm sure talking with 12 year olds about the dangers of having sex will have a much more profound effect than not talking to them (like most parents and schools). I'm sure that 12 year olds need information and probably need to be told to wait.

BUT, the big question is whether this type of education would work with older students? Would older students be better served with receiving both abstinance and safe/healthy sex education?

This study doesn't stand for the proposition that abstinance only should be applied to every age group, but it does seem to indicate that if you catch the kids young enough, you may be able to delay the inevitable... hopefully long enough for the "real" sex-ed to teach them how not to get a disease or have a litter of babies.

I'm interested in seeing an exact breakdown of the "abstinence-based" program this study is based on versus "abstinence-only" programs that have been proven to be a failure in the past.

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I don't have electronic access to this journal right now, but I really want to read this article... I'll have to hit up some friends who can get it for me, or get my med library to get me a print copy. The NYT did share this tidbit (this person seems to be commenting from a pro-abstinence interest group -- she's quoted in the WP article, too):

NYTimes said:

Ms. Brown noted that the abstinence-only classes in the Jemmott study centered on people with an average age of 12 and that unlike the federally supported abstinence programs now in use, did not advocate abstinence until marriage.

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So at least some part of it is that this curriculum encouraged 12 year olds to not have sex soon (which I think, is actually a goal with which most liberals and conservatives would agree), whereas those previous interventions asked adolescents of varying ages to not have sex until they got married.

I have to say that my personal aside is that, when I was around 14-15, I went to a very evangelical church with my best friend, a preacher's kid. They did their own abstinence promotion, and got people to stand up and pledge to be abstinent until marriage (IIRC I made the pledge but have since broken it), and, well, that PK did get his girlfriend pregnant while we were freshmen in college....

Ok, I can't be the only one who noticed the age. These are 12 year old kids being forced to sit through an 8 hour or 12 hour abstinance only program.

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In this case, the age was apparently chosen as the earliest age at which there would be a substantial number of individuals who had sex for the first time in the follow-up window, without the study.

NYTimes said:

“Because African-Americans tend to have a higher rate of early sexual initiation than others, we thought that within two years, a reasonable number would start having sex,” Dr. Jemmott said. “If we went younger, we couldn’t show that intervention works.”

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(e.g., if they did this study on 10 year olds, so few would have sex in the next two years, that statistically finding a significant effect would be unlikely or require a very large sample size.)

The best sex ed course I ever took while in highschool involved discussion of all alternatives including abstinence, and the most convincing part of the class was the pictures of the "exploded penis" as a teenager it didn't make me stop wanting sex but it sure did convince me to wear a rubber and keep a lice comb in my wallet just in case.

From what I've read of this study in the NYT and a few other sources, the principle seems to largely support what liberals have been saying for years: don't demonize sex.

It seems from a few sources that the researchers didn't tell kids to not have sex until marriage, but rather to abstain until they felt they were prepared for it. What's more, condom use was still portrayed as important as a preventative measure, something that is notably absent from the conventional abstinence-only model which says that you won't need a condom if you just abstain.

Finally, the religious element was removed. Most of the abstinence-only programs that had cropped up in the past decade were based heavily on Christianity and were very heavy on judgement and light on practicality.

This study did what I think is the most practical, realistic, and honest way to deal with the ever so messy topic of sex and kids: don't lie, don't moralize, and allow kids to feel empowered, because when you do, you'll realize that kids are remarkably sharp at knowing when they are ready for something.

From what I've read of this study in the NYT and a few other sources, the principle seems to largely support what liberals have been saying for years: don't demonize sex.

It seems from a few sources that the researchers didn't tell kids to not have sex until marriage, but rather to abstain until they felt they were prepared for it. What's more, condom use was still portrayed as important as a preventative measure, something that is notably absent from the conventional abstinence-only model which says that you won't need a condom if you just abstain.

Finally, the religious element was removed. Most of the abstinence-only programs that had cropped up in the past decade were based heavily on Christianity and were very heavy on judgement and light on practicality.

This study did what I think is the most practical, realistic, and honest way to deal with the ever so messy topic of sex and kids: don't lie, don't moralize, and allow kids to feel empowered, because when you do, you'll realize that kids are remarkably sharp at knowing when they are ready for something.

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Couldn't have put it better, and that's exactly how it was 19 years ago in my public school health class too....I have no idea what the **** they were thinking screwing with a perfectly good health class topic in the years since I graduated.

Fair enough... let's do more trials but the initial results are just cause to re-examine abstinence-based intervention and start applying it in other training programs! You seem reluctant to accept these initial positive results even though the results are quite clear.

Could you explain that further? Sure seems like these initial trials validate the abstinence-based education that conservatives have supported for years and years... the distinction you're trying to make is lost on me. Church and religious groups have advocated abstinence-based education for decades and conservatives have stood behind such education. Know who has consistently opposed such education? The NEA teacher's lobby and liberals. So if these trials continue and initial results are validated can we expect to see change?

Done now. So I assume abstinence-based education opponents will now change their tune when further trials validate the initial data? Or will they likely - as I expect - downplay the results?

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Abstinence-based education is logic fail simply put.

It doesn't make teenagers any less horny which is the whole problem. It just like many other failed policies the adults teaching it feel better. Young people are going to have sex NO MATTER what you do. This is a guarantee. It's an instinct.

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